Prevention Matters

An important article in Preventive Medicine underscores the important role that urban design can play in promoting healthy communities. The research comes from an Atlanta project and will be a featured presentation at the 18th Annual Congress of the New Urbanism to be held in Atlanta May 19-22 in partnership with the Centers for Disease Control and Prevention.

The theme of this year’s conference is appropriately enough “New Urbanism: Rx for Healthy Places.”

Those of us in the prevention community need to pay more attention to this “New Urbanism.” Their work is very much at the cutting edge of new, community-based initiatives that can help us achieve success in reducing the incidence of chronic disease.

Want to learn more? There is an engaging 3 minute You Tube video introduction to “New Urbanism” called “Built to Last.” The video explains how this innovative approach to community design helps people replace dependency on driving with the freedom to connect with their community on foot, bicycle, or public transit. And there’s more. The correct approach to community design can help reverse the harmful effects of urban sprawl on the environment AND effect, in a good way, our personal and community health. New Urbanism seems like a strong investment in our future.

“When it comes to saving the planet what we build is the greatest threat … or the greatest hope.”

Posted by:
Ripley Forbes
Director, Government Affiars, Partnership for Prevention

President Obama today released his proposal for resolving the impasse with Congress over health reform. The proposal is summarized in an 11 page document released this morning by the White House. Initially prevention advocates were shocked to discover that the words “prevention” and “wellness” were not included in the summary draft. Fortunately, these concerns were premature as the release of additional information highlighted the key role that prevention plays in the Administration’s plan for reform.

We have since discovered that the 11 page summary was intended primarily to highlight proposed changes in the Senate passed health reform bill; HR 3590, the “Patient Protection and Affordable Care Act.”

The White House has developed a detailed web site which discusses the President’s proposal in greater detail. Most encouraging to those of us who believe REAL Health Reform Starts with Prevention, the President has made crystal clear his Administration’s continued support for the key prevention, public health and wellness provisions contained in Title IV of the Senate passed health reform bill. By retaining the Senate proposal for the prevention trust fund, the proposal “provides for unprecedented investments in prevention, public health, disease research, and screening. The national investment in preventing disease and finding cures will save lives and money in the long run for American families, small businesses, and the Nation.”

The President’s commitment to prevention is reflected in the following description of the Prevention and Public Health provisions of Title IV.

“If we want to truly reform health care to benefit American families, we need to transition from a system focused primarily on treating the sick to one that helps keep people well throughout their lives…It directs the creation of a national prevention and health promotion strategy that incorporates the most effective and achievable methods to improve the health status of Americans and reduce the incidence of preventable illness and disability in the United States. The Act relies on the innovation of small businesses and state and local governments to find the best ways to improve wellness in the workplace and in our communities. And it strengthens America’s capacity to respond to public health emergencies. The Act empowers families by giving them tools to find the best science-based nutrition information, and it makes prevention and screenings a priority by waiving co-payments for America’s seniors on Medicare. By attacking disease before it hits, the Act helps to improve health, save lives, and avoid more costly complications down the road.”

Additional details about the President’s health reform proposal are summarized on a white house web site that has been developed in preparation for the bipartisan health summit scheduled for February 25. The summit will begin at 10am and will be broadcast live at whitehouse.gov/live.

Posted by:
Ripley Forbes
Director, Government Affairs, Partnership for Prevention

The cover story for a recent edition of Business Week was entitled “10 Ways to Cut Health Care Costs Right Now.” The article focused on making improved health a community effort, and it began by talking about the work being done by the Rochester Business Alliance to address obesity and physical activity in Rochester, New York.

We’re going to discuss those efforts today with Paul Speranza, who is Vice Chairman and General Counsel of Rochester-based Wegmans Food Markets, a integral partner in this effort. To listen to the podcast, just click on the media player below. If there is no media player below, click here.

Partnership for Prevention sent a letter to congressional negotiators on the health reform bill urging them to maintain the independence and expertise of the federal task forces for clinical and community prevention services. The House and Senate bills both have provisions that would change the role and structure of the US Preventive Services Task Force and the Community Preventive Services Task Force.

"It is vital that  each body continue to offer unbiased, objective recommendations that can inform physicians, public health officials, and other health professionals about the quality of evidence of clinical and community services," Partnership President/CEO Robert J. Gould wrote Sen. Tom Harkin, D-Iowa, and Sen. Henry Waxman, D-Calif.

"...To maintain this scientific independence, it is absolutely essential that task force members have the necessary training and expertise to fulfill their primary responsibility: the review of scientific evidence related to the effectiveness of clinical and community preventive services and applying this evidence to decision-making.

"Any other qualifications for appointment, such as expertise in employer health or school health or clinical experience, should be a supplemental qualification and not an alternative..." he concluded.

Suzanne Bohan and Sandy Kleffman write in the Contra Costa Times about  "unprecedented — yet uncontroversial — disease prevention initiatives whose inclusion has been lost in the rancorous debate over health care reform legislation working its way through Congress."

Such initiatives provide federally funded security guards at dangerous neighborhood parks and federal grants to poor neighborhoods to build grocery stores or to keep school gyms open after hours.

"The prevention provisions mark a victory for advocates and federal lawmakers who for years have unsuccessfully sought more federal funding to close the gap in health disparities and life expectancies between richer and poorer Americans," Bohan and Kleffman write.

In a recent Chicago Tribune interview, Partnership for Prevention President Robert J. Gould said making healthy choices easier will help create a "culture of health."
"If we lower the barriers to making healthier choices in the community, then we can create a culture of health in this country," Gould told Tribune reporter Julie Deardorff.

Deardorff's article undescored Gould's assertion by citing a recent report in the Archives of Internal Medicine.  That study found that people who live in "healthy" neighborhoods -- areas with plentiful opportunities for physical activity and eating well -- had a 38 percent lower rate of Type 2 diabetes than those in "unhealthy" neighborhoods.

Worksite programs help employees lose weight, according to a systematic review published in the October issue of the American Journal of Preventive Medicine. On the basis of strong evidence of their effectiveness, the U.S. Task Force on Community Preventive Services (Task Force) recommends worksite programs intended to improve diet and/or physical activity behaviors for reducing weight among employees. These programs include various approaches to support behavior change, such as informational and educational activities, behavioral and social strategies, and policy and environmental approaches.

A San Francisco program that turns unused roadway areas into parks was named Partnership for Prevention's "Best Prevention Idea of the Week," while federal officials’ delay in informing schools about potentially tainted food was named “Worst Prevention Idea of the Week.”

The Best/Worst Idea awards are a regular feature of Prevention Matters, the blog of Partnership for Prevention. Each week, Partnership for Prevention's staff will choose the designees based on nominations of items in the previous week's news submitted by members, staff and the public at large. To submit a nomination or for more information, contact Damon Thompson at dthompson@prevent.org.


BEST

SF PROGRAM TRANSFORMS PAVEMENT INTO PARKS
http://arieff.blogs.nytimes.com/2009/09/22/pavement-to-parks/?emc=eta1

San Francisco’s “Pavement to Parks” program creates green spaces where people can walk and be active by reclaiming excess roadway, through the use of simple and low-cost design interventions. A pro bono designer works on each park (there are 12 scheduled to be finished through 2010; three have just been completed) with the mandate of using materials the city already has to maximize greenery and “transform a sea of asphalt.”

WORST

U.S. DELAYED TELLING SCHOOLS ABOUT FOOD RECALLS
http://www.msnbc.msn.com/id/32989396/ns/health-kids_and_parenting/?ocid=twitter/from/ET

The federal government failed to inform schools of recalls of suspected tainted food products, potentially putting millions of schoolchildren at risk of food poisoning over the last two years, a government investigation has concluded. The recalled foods included salmonella-tainted peanut products linked to the deaths of at least nine people, said the report, which was completed last month by the Government Accountability Office, the investigative arm of Congress.

A new report from the Institute of Medicine and National Research Council outlines strategies that local government officials can use to tackle the childhood obesity epidemic in their communities. They include zoning restrictions on fast-food restaurants near schools and playgrounds, community policing to improve safety around public recreational sites, requirements that publicly run after-school programs limit video game and TV time, and taxes on high-calorie, low-nutrient foods and drinks.

The report highlights several examples of ways that officials have promoted healthier lifestyles in communities ranging from big cities to small towns. It also recommends starting points that could help officials initiate childhood obesity prevention plans tailored to their jurisdictions' resources and needs.

Can a person's health be improved outside of the doctor's office or hospital? Some Republican lawmakers apparently think not.

Rep. Tim Murphy, R-Pa., a psychologist and co-chair of both the Mental Health Caucus and the GOP Doctors Caucus, dismisses proposals to fund infrastructure projects through community prevention measures in the health reform bills being crafted by Congress.

The Chicago Tribune says he "stresses the importance of preventive measures ... (b)ut Murphy thinks infrastructure projects like bike trails would probably best belong in a transportation bill. The health care bill itself, he believes, must address how care can be delivered more effectively and efficiently by doctors and hospitals."

In making such statements, Murphy apparently overlooks the fact that the US Task Force on Community Preventive Services - an independent panel of experts sponsored by the Centers for Disease Control and Prevention - has identified more than 60 policies and programs that are proven to address the nation's most serious preventable health problems, like obesity and smoking. These policies, which are implemented outside of a doctor's office or hospital, help create environments that facilitate good nutrition choices and create safe places and opportunities in which people can engage in physical activity.

A draft Senate bill would provide up to $10 billion annually for a prevention and public health investment fund -- a portion of which could be used for projects such as bike paths, sidewalks, farmers markets and other community interventions meant to curb chronic and costly conditions like obesity.

So let's get this straight - chronic diseases are underlying drivers of our current health care expenditures; many of these chronic disesases can be largely prevented through good nutrition and increased physical activity; good nutrition and increased physical activity can be increased through non-clinical programs; but the health reform bill should only concentrate on things that happen in doctor's offices and hospitals? Hopefully, Rep. Murphy will re-think this stance.

The more than 2,600 YMCAs of the USA are not only the largest not-for-profit community service organizations in the United States; they also are collectively the nation’s largest providers of health and well-being programs, serving 21 million children and adults of all ages, races, faiths, backgrounds, abilities and income levels. The YMCAs have committed themselves to providing community preventive services that encourage healthy lifestyles. In some cases, they've proven an ability to deliver those services effectively at a fraction of the normal cost. On this show, we’re discussing their programs with Katie Clarke Adamson, Director of Health Partnerships and Policy for YMCA of the USA. To listen the podcast, click on the media player below; if you do not see a media player, click here.

Chris Norwood, the founder and Executive Director of Health People: Community Preventive Health Institute in the South Bronx, has a column in the Huffington Post in which she stakes a strong claim for community-based prevention as part of health reform.

"For the United States, health reform without a clear plan to mobilize community groups nationwide to put proven prevention programs right in place where they are most needed, will not be "reform", but a continuing disaster in which people are simply more equal in being able to obtain expensive medical "care" for dehabilitating conditions that often could have been prevented," she writes.

"We will be able to judge both the real intent of the medical industrial complex - and the Obama Administration and the Senate and Congress - by their support for community-based prevention," she continues. "Right now, it is still routine to read in discussions of healthcare reform that "real" reductions in our overwhelming rates of chronic disease aren't possible---and that it just not true. What analysts who say that are not admitting is that while the ordinary ways of the health care system--drugs, "treatments", surgery, etc.---cannot reduce chronic disease rates, getting prevention out of the health care system, itself, can."

In 2005, Norwood was one of 1,000 women from around the world chosen for a groundbreaking Nobel Peace Prize nomination honoring women’s local work.